急性心肌梗死患者急诊PCI术后血浆B型钠尿肽水平变化及意义

The change and meaning of plasma B type natriuretic peptide level in acute myocardial infarction patients after emergency percutaneous coronary interention

目的观察急性心肌梗死(AMI)患者血浆B型钠尿肽(BNP)水平变化,并分析其与左心室重构(LVRM)及预后的关系。方法选择首次AMI住院患者112例,均行急诊经皮冠状动脉介入术(PCI),梗死相关动脉(IRA)开通69例(开通组)、未开通43例(未开通组)。入院时检测心肌损伤指标[CK、CK-MB、肌钙蛋白I(cTnI)],入院第7天超声检查左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI),测定入院时、AMI后24 h、入院第7天血浆BNP(记为BNP1、BNP2、BNP3);术后随访2 a,记录心血管不良事件(MACE)发生情况。结果两组入院时血清CK、CK-MB、cTnI、TG、LDL-C比较,P均>0.05;入院后第7天,开通组较未开通组LVEF升高(P<0.05);两组BNP1差异无统计学意义,BNP2明显高于BNP1、BNP3(P均<0.05),未开通组BNP2、BNP3较开通组明显升高(P均<0.01)。AMI患者3个时点血浆BNP与LVEDVI、CK、CK-MB、cTnI均呈正相关(P均<0.01),与LVEF呈负相关(P均<0.01)。开通组2 a内发生MACE 10例,未开通组16例,P<0.01;BNP2预测AMI急诊PCI患者2 a内MACE的ROC曲线下面积为0.791,P<0.05;其分界值为332 ng/L时,预测MACE的敏感性为76.9%、特异性为73.3%。结论 AMI急诊PCI术后血浆BNP水平升高,其水平变化有助于判断IRA开通情况;AMI后24 h血浆BNP水平可预测患者MACE,有助于更早了解LVRM情况,以阻止或减缓AMI后心力衰竭的发生、发展。

Objective To observe the change of plasma B type natriuretic peptide（BNP） level in acute myocardial infarction patients after emergency percutaneous coronary interention （PCI）,and analyze the relationship between it and left ventricular remodeling （LVRM）,prognosis.Methods Choose 112 cases of hospitalized patients with initial AMI,all underwent PCI,infarction related artery （IRA） opened in 69 cases （opened group）,did not open in 43 cases （not opened group）.On admission to detect myocardial injury markers [CK,CK-MB,troponin I （cTnI）],to measure left ventricular ejection fraction （LVEF）,left ventricular end-diastolic volume index （LVEDVI）on the seventh day of admission by using ultrasound.To measure the level of BNP in plasma on admission,24 hours after AMI,the seventh day of admission （marked them as BNP1,BNP2,BNP3 respectively） ; Postoperative follow-up of 2 years,recording the occurrence of major adverse cardiovascular events （MACE）.Results Comparing serum level of CK,CK-MB,cTnI,TG,LDL-Cin two groups on admission,P ＞ 0.05 ; 7 days after admission,the level of LVEF in comparing opened group was higher than not opened group （P ＜ 0.05）,BNP1 had no statistically significant differences between the two groups,BNP2 increased significantly more than BNP1,BNP3 （P ＜ 0.05）,the level of BNP2,BNP3 increased significantly in opened group than not opened group （P ＜ 0.01）.BNP had positive correlation with LVEDVI,CK,CK-Mb and cTnI,and negatively related with LVEF in three time points detection （P ＜0.01）.There were 10 MACE cases in opened group,16 cases in not opened group,P ＜ 0.01 ; The area under the ROC curve of BNP2 predicting MACE within 2 years was 0.791,P ＜0.05 ; the boundary value of 332 ng/L,sensitivity of MACE prediction was 76.9％,specificity was 73.3％.Conclusions The level of BNP in AMI patients after PCI is higher,the change is helpful to judge open case of IRA ; The BNP level in AMI patients 24 h after PCI can predict MACE,help to understand LVRM earlier,to prevent or slow down the occurrence and development of heart failure after AMI.